住院成人呼吸道合胞病毒感染患者的预后：一项多中心回顾性队列研究。

Prognosis of hospitalised adult patients with respiratory syncytial virus infection: a multicentre retrospective cohort study.

机构信息

Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010 Créteil, France; Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, 94010 Créteil, France.

Univ Paris Est Créteil, INSERM, IMRB, F-94010 Créteil, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Department of Public Health, F-94010 Créteil, France.

出版信息

Clin Microbiol Infect. 2023 Jul;29(7):943.e1-943.e8. doi: 10.1016/j.cmi.2023.03.003. Epub 2023 Mar 11.

DOI:10.1016/j.cmi.2023.03.003

PMID:36914069

Abstract

OBJECTIVES

Respiratory syncytial virus (RSV) is a common agent of viral respiratory infections with significant morbidity and mortality in adults. The objective of this study was to determine risk factors for mortality and invasive mechanical ventilation and to describe the characteristics of patients who received ribavirin.

METHODS

A retrospective multicentre observational cohort study was conducted in Great Paris area hospitals, including patients hospitalised between 1 January 2015 and 31 December 2019 for documented RSV infection. Data were extracted from the Assistance Publique-Hôpitaux de Paris Health Data Warehouse. The primary endpoint was in-hospital mortality.

RESULTS

One thousand one hundred sixty-eight patients were hospitalised for RSV infection, including 288 (24.6%) patients who required intensive care unit (ICU) admission. The median (interquartile range) age of patients was 75 (63-85) years, and 54% (n = 631/1168) of them were women. In-hospital mortality was 6.6% (n = 77/1168) in the whole cohort and 12.8% (n = 37/288) in ICU patients. Factors associated with hospital mortality were age >85 years (adjusted odds ratio [aOR] = 6.29, 95% confidence interval [2.47-15.98]), acute respiratory failure (aOR = 2.83 [1.19-6.72]), non-invasive (aOR = 12.60 [1.41-112.36]), and invasive mechanical ventilation support (aOR = 30.13 [3.17-286.27]) and neutropenia (aOR = 13.19 [3.27-53.27]). Factors associated with invasive mechanical ventilation were chronic heart (aOR = 1.98 [1.20-3.26]) or respiratory failure (aOR = 2.83 [1.67-4.80]), and co-infection (aOR = 2.62 [1.60-4.30]). Patients who were treated with ribavirin were significantly younger than others (62 [55-69] vs. 75 [63-86] years; p < 0.001), more frequently males (n = 34/48 [70.8%] vs. n = 503/1120 [44.9%]; p 0.001), and almost exclusively immunocompromised (n = 46/48 [95.8%] vs. n = 299/1120 [26.7%]; p < 0.001).

DISCUSSION

The mortality rate of patients hospitalised with RSV infections was 6.6%. Twenty-five per cent of the patients required ICU admission.

摘要

目的

呼吸道合胞病毒（RSV）是一种常见的病毒性呼吸道感染病原体，在成人中具有显著的发病率和死亡率。本研究旨在确定与死亡率和有创机械通气相关的危险因素，并描述接受利巴韦林治疗的患者的特征。

方法

这是一项在大巴黎地区医院进行的回顾性多中心观察队列研究，纳入了 2015 年 1 月 1 日至 2019 年 12 月 31 日期间因确诊 RSV 感染而住院的患者。数据从巴黎公立医院集团健康数据仓库中提取。主要终点为院内死亡率。

结果

共有 1168 例患者因 RSV 感染住院，其中 288 例（24.6%）需要入住重症监护病房（ICU）。患者的中位（四分位距）年龄为 75 岁（63-85 岁），54%（n=631/1168）为女性。全队列的院内死亡率为 6.6%（n=77/1168），ICU 患者的死亡率为 12.8%（n=37/288）。与住院死亡率相关的因素包括年龄>85 岁（校正比值比[aOR] 6.29，95%置信区间[2.47-15.98]）、急性呼吸衰竭（aOR 2.83 [1.19-6.72]）、非侵入性（aOR 12.60 [1.41-112.36]）和有创机械通气支持（aOR 30.13 [3.17-286.27]）以及中性粒细胞减少症（aOR 13.19 [3.27-53.27]）。与有创机械通气相关的因素包括慢性心脏（aOR 1.98 [1.20-3.26]）或呼吸衰竭（aOR 2.83 [1.67-4.80]）以及合并感染（aOR 2.62 [1.60-4.30]）。接受利巴韦林治疗的患者明显比其他患者年轻（62 [55-69]岁 vs. 75 [63-86]岁；p<0.001），更常为男性（n=34/48 [70.8%] vs. n=503/1120 [44.9%]；p<0.001），几乎全部为免疫功能低下（n=46/48 [95.8%] vs. n=299/1120 [26.7%]；p<0.001）。